License information for International Medical Graduates in California Step by Step Guide

Application information for a Physician’s and Surgeon’s License Licensees are authorized to use drugs or devices, to sever or penetrate tissues, and to use any and all methods in the treatment of diseases, injuries, deformities and other physical and mental conditions To be eligible for a Physician’s and Surgeon’s license, applicants must have received all of their medical school education from and graduated from a medical school recognized or approved by the Medical Board of California (Board) Some recognized medical schools that teach in their native language are opening English language medical school programs. The English language programs are not recognized unless specifically stated by the Board The Medical School’s name must exactly match the name on the Board’s list of recognized medical schools Refer to the Board’s website to verify your medical school is recognized: http://www.mbc.ca.gov/applicants/medical_schools/schools_recognized.aspx

Physician’s and Surgeon’s License Application Checklist 1) Application, fees and fingerprints Application Fee $491 Initial License Fee $808.00 or Reduced Initial License Fee $416.50 Application for Physician’s and Surgeon’s License, Forms L1A-L1F Fingerprints: Live Scan Form 2) Examination Documentation* ECFMG Certification Status Report Official Examination Scores from the Federation of State Medical Boards (FSMB) *IMGs who have been issued a PTAL have already met the educational requirements. Once the postgraduate training and final examination requirements have been met, additional forms will be needed to complete the application for licensure

Physician’s and Surgeon’s License Application Checklist 3) Medical Education Documentation* Certificate of Medical Education, Form L2 Official Medical School Transcript Certified Copy of Medical School Diploma Certified English Translations (if applicable) Certificate of Clinical Training, Form L5 Certificate of Individual Clinical Clerkship Training, Form L6 (if applicable) 4) Postgraduate Training Documentation Certificate of Completion of ACGME Postgraduate Training, Forms L3A-L3B Current Postgraduate Training Enrollment, Form L4 *IMGs who have been issued a PTAL have already met the educational requirements. Once the postgraduate training and final examination requirements have been met, additional forms will be needed to complete the application for licensure

Physician’s and Surgeon’s License Application Checklist 5) Verification of Medical License(s) License Verification (if applicable) 6) Other Items Curriculum Vitae (CV) Timeline of Activities Birth Month Licensure Request Explanation to Application Question (if applicable)

1) Application, fees and fingerprints

SAMPLE APPLICATION FEE Physician’s and Surgeon’s License Application and Initial License Fee SAMPLE APPLICATION FEE The application fee is non refundable Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

SAMPLE APPLICATION FEE PTAL Physician’s and Surgeon’s License Application and Initial License Fee SAMPLE APPLICATION FEE The application fee is non refundable Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov 491.00

All six forms must be submitted together Physician’s and Surgeon’s License Application: Forms L1A-L1F ✓ SAMPLE L1A Complete all fields, answer all questions and have the application notarized All six forms must be submitted together Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

All six forms must be submitted together PTAL Physician’s and Surgeon’s License Application: Forms L1A-L1F ✓ ✓ SAMPLE L1A Complete all fields, answer all questions and have the application notarized All six forms must be submitted together Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

All six forms must be submitted together PTAL Physician’s and Surgeon’s License Application: Forms L1A-L1F ✓ ✓ USMLE Step 1 USMLE Step 2 CS USMLE Step 2 CK USMLE Step 3 mm/dd/yy SAMPLE L1B Complete all fields, answer all questions and have the application notarized All six forms must be submitted together Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

All six forms must be submitted together PTAL Physician’s and Surgeon’s License Application: Forms L1A-L1F ✓ SAMPLE L1B Complete all fields, answer all questions and have the application notarized All six forms must be submitted together Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

All six forms must be submitted together PTAL Physician’s and Surgeon’s License Application: Forms L1A-L1F ✓ ✓ SAMPLE L1C Complete all fields, answer all questions and have the application notarized All six forms must be submitted together Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

All six forms must be submitted together PTAL Physician’s and Surgeon’s License Application: Forms L1A-L1F ✓ ✓ SAMPLE L1C Complete all fields, answer all questions and have the application notarized All six forms must be submitted together Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

All six forms must be submitted together PTAL Physician’s and Surgeon’s License Application: Forms L1A-L1F ✓ SAMPLE L1D Complete all fields, answer all questions and have the application notarized All six forms must be submitted together Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

All six forms must be submitted together ✓ Physician’s and Surgeon’s License Application: Forms L1A-L1F ✓ SAMPLE L1D Complete all fields, answer all questions and have the application notarized All six forms must be submitted together Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

All six forms must be submitted together PTAL ✓ Physician’s and Surgeon’s License Application: Forms L1A-L1F ✓ SAMPLE L1E Complete all fields, answer all questions and have the application notarized All six forms must be submitted together Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

All six forms must be submitted together ✓ Physician’s and Surgeon’s License Application: Forms L1A-L1F ✓ SAMPLE L1E Complete all fields, answer all questions and have the application notarized All six forms must be submitted together Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

All six forms must be submitted together PTAL ✓ Physician’s and Surgeon’s License Application: Forms L1A-L1F ✓ SAMPLE L1F Complete all fields, answer all questions and have the application notarized All six forms must be submitted together Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

All six forms must be submitted together PTAL ✓ Physician’s and Surgeon’s License Application: Forms L1A-L1F ✓ SAMPLE L1F Complete all fields, answer all questions and have the application notarized All six forms must be submitted together Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

to obtain the names, location, and fees of approved fingerprint sites PTAL ✓ Physician’s and Surgeon’s License Fingerprints: Live Scan Form ✓ Criminal Records Check from both the California Department of Justice and The Federal Bureau of Investigation must be received prior to the issuance of a Physician’s and Surgeon’s medical license NOTE: If you have ever been convicted, the record of conviction will be reported to the Board as a result of your fingerprint inquiry. The Board receives results for all convictions: misdemeanors, felonies, infractions and citations. If in doubt, it’s better to answer “yes” on the L1E form and include an explanation The “Request For Live Scan Service” form is required to have your fingerprints processed by Live Scan. This form must be completed in triplicate Ensure that all personal data (name, AKA’s, date of birth, sex, height, weight, eye color, hair color, place of birth, Social Security Number or Individual Taxpayer Identification Number, California’s driver’s license number and home address) is provided on each of the three forms The last section of the form requires information from the fingerprint agency; please ensure this information is completed or the forms will be void It your responsibility to ensure that the person scanning the fingerprints submits TWO digital prints, one for the DOJ and one for the FBI Access the website http://ag.ca.gov/fingerprints/publications/contact.html to obtain the names, location, and fees of approved fingerprint sites Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

SAMPLE LIVE SCAN FORM PTAL Physician’s and Surgeon’s License ✓ Physician’s and Surgeon’s License Fingerprints: Live Scan Form ✓ SAMPLE LIVE SCAN FORM Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

SAMPLE LIVE SCAN FORM PTAL Physician’s and Surgeon’s License ✓ Physician’s and Surgeon’s License Fingerprints: Live Scan Form ✓ SAMPLE LIVE SCAN FORM Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

SAMPLE LIVE SCAN FORM Physician’s and Surgeon’s License ✓ Physician’s and Surgeon’s License Fingerprints: Live Scan Form ✓ SAMPLE LIVE SCAN FORM Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

2) Examination Documentation ✓ IMGs who have been issued a PTAL have already met the educational requirements. Once the postgraduate training and final examination requirements have been met, additional forms will be needed to complete the application for licensure

3) Medical Education Documentation ✓ IMGs who have been issued a PTAL have already met the educational requirements. Once the postgraduate training and final examination requirements have been met, additional forms will be needed to complete the application for licensure

4) Postgraduate Training Documentation

Physician’s and Surgeon’s License Certificate of Completion of ACME Postgraduate Training, Forms L3A-L3B A Certificate of completion of ACGME Postgraduate Training, Form L3A-L3B, is required to verify the completion of each year of accredited training The form may not be signed and dated prior to the last day of the training year that will be used to meet the two years of ACGME accredited postgraduate training required for licensure A Form L3A-L3B must be submitted to each postgraduate training program for completion The current program director must provide all of the required information and responses on the form, sign and date the form, and affix the hospital seal. If a hospital seal is not available, the program director must sign in the presence of a notary and the notary seal must be affixed A “yes” response to any of the Unusual Circumstances questions on Form L3A requires a signed and dated letter of explanation from the current program director The completed Form L3A-L3B must be mailed directly from the program to the Board to be acceptable. Any letters of explanation must be provided on program letterhead, signed by the program director and mailed directly to the Board Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

SAMPLE L3A Physician’s and Surgeon’s License Certificate of Completion of ACME Postgraduate Training, Forms L3A-L3B SAMPLE L3A ✓ Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

SAMPLE L3A Physician’s and Surgeon’s License Certificate of Completion of ACME Postgraduate Training, Forms L3A-L3B SAMPLE L3A Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

SAMPLE L3B Physician’s and Surgeon’s License Certificate of Completion of ACME Postgraduate Training, Forms L3A-L3B SAMPLE L3B Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

SAMPLE L3B Physician’s and Surgeon’s License Certificate of Completion of ACME Postgraduate Training, Forms L3A-L3B SAMPLE L3B Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

SAMPLE L4 Physician’s and Surgeon’s License Current Postgraduate Training Enrollment, Form L4 SAMPLE L4 ✓ Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

Physician’s and Surgeon’s License Current Postgraduate Training Enrollment, Form L4 If you are enrolled in an accredited training program at the time of application, this form is necessary to be eligible for the reduced initial licensing fee Complete the top section and submit the form to your current training program for completion The current program director must provide all of the required information and responses on the form, sign and date the form, and affix with the hospital seal. If a hospital seal is not available, the program director must sign in the presence of a notary and the notary seal must be affixed The completed Form L4 must be mailed directly from the program to the Board to be acceptable Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

SAMPLE L4 Physician’s and Surgeon’s License Current Postgraduate Training Enrollment, Form L4 SAMPLE L4 Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

5) Verification of Medical License(s)

Physician’s and Surgeon’s License License Verification (if applicable) License verification is required from each state or Canadian province in which you hold or have held a medical license Verification of temporary, training, or provisional license(s) are not required The official license verification must be sent directly from the licensing authority to the Board Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

6) Other Items

Physician’s and Surgeon’s License Curriculum Vitae (CV) Submit a signed and dated current CV with your Application Example Name, MD Address Contact Number E-mail EDUCATION CLINICAL EXPERIENCE RESEARCH AND PUBLICATIONS CO-CURRICULAR ACTIVITIES COURSES AND CONFERENCES REFERENCES Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

SAMPLE TIMELINE OF ACTIVITIES Physician’s and Surgeon’s License Timeline of Activities SAMPLE TIMELINE OF ACTIVITIES Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

SAMPLE TIMELINE OF ACTIVITIES Physician’s and Surgeon’s License Timeline of Activities A complete timeline from the graduation of medical school to present is required. Provide the Board with a written chronological description of all your professional and non-professional activities with no gaps. If you have completed any externships, observerships, or volunteers activities in California, please include a detailed description of your duties and responsibilities along with the location and name of the supervising physician. Mail your signed and dated timeline of Activities form directly to the Board SAMPLE TIMELINE OF ACTIVITIES Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

and submit the form directly to the Board Physician’s and Surgeon’s License Birth Month Licensure Request California licensing regulations specify that a license expires at 12 midnight on the last day of the birth month of the licensee during the second year of a two year term If you are licensed in your birth month, your initial license will be valid for a full 24-month term If you are licensed in a month other than your birth month, the term of your initial license will be less than 24-months Complete the Birth Month Licensure Request form indicating your preference and submit the form directly to the Board Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

SAMPLE BIRTH MONTH LICENSURE REQUEST Physician’s and Surgeon’s License Birth Month Licensure Request SAMPLE BIRTH MONTH LICENSURE REQUEST Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

SAMPLE BIRTH MONTH LICENSURE REQUEST Physician’s and Surgeon’s License Birth Month Licensure Request SAMPLE BIRTH MONTH LICENSURE REQUEST Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

SAMPLE EXPLANATION TO APPLICATION QUESTIONS Physician’s and Surgeon’s License Explanation to Application Questions (if applicable) SAMPLE EXPLANATION TO APPLICATION QUESTIONS Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

SAMPLE EXPLANATION TO APPLICATION QUESTIONS Physician’s and Surgeon’s License Explanation to Application Questions (if applicable) SAMPLE EXPLANATION TO APPLICATION QUESTIONS Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

ADDITIONAL INFORMATION

Physician’s and Surgeon’s License Additional Information A license cannot be issued to an IMG until the applicant has passed USMLE Step 3 California law requires that the applicant must pass Step 3 of the USMLE within not more than four attempts An IMG must complete 24 months of training to be eligible for licensure; the final 12 months used towards eligibility must be continuous and in a single program An IMG must be licensed by the end of the 36th month of training In calculating these months, the Board counts all approved training in the US, whether or not credit was granted Allow 2-4 weeks from the date of issuance to receive your pocket identification card and wall certificate Address: 2005 Evergreen, Suite 1200, Sacramento, CA 95815-3831 Phone: (916) 263-2382 or (800) 633-2322 Fax: (916) 263-2487 Website: www.mbc.ca.gov

License information for International Medical Graduates in California Step by Step Guide